L.A. Care Medicare Plus (HMO D-SNP) coordinates Medicare and Medi-Cal benefits under one health plan to offer a network of providers and pharmacies that will provide your Medicare and Medi-Cal services and Medicare Part D prescription drugs in one place.
Special Notice
Did you know that L.A. Care Medicare Plus members can access their Dental Benefits through Medi-Cal Dental? For questions about your dental coverage, or if you need help finding a Medi-Cal Dentist in your area, please call L.A. Care Medicare Plus at 1-833-522-DSNP (3767), TTY: 711 or Medi-Cal Dental: 1-800-322-6384, TTY: 1-800-735-2922.
Members of L.A. Care Medicare Plus in 2023 will have:
Fitness Benefit
SilverSneakers® is a no-cost fitness benefit L.A. Care Medicare Plus members. This exciting program offers members access to more than 15,000 locations nationwide where you can use equipment and take group exercise classes. It also provides online and on-demand classes for at-home workouts.
Learn more about by visiting our SilverSneakers web page.
Nurse Hotline
L.A. Care members can call a team of professional nurses 24 hours a day, 7 days a week, 365 days a year at 1.800.249.3619 (TTY: 711). A nurse will answer health care questions, provide additional information and guidance, or recommend the appropriate level of care, all in the language of choice at no cost.
Telehealth
In addition to in-person visits with your doctor, telehealth offers access to doctors by phone or video chat 24 hours a day, seven days a week. Teladoc® is the telehealth company that L.A. Care is working with to offer this care option when a primary care doctor is not available. Teladoc doctors can diagnose and treat minor illnesses, allergies and skin conditions — all by phone or video chat. They can prescribe medication if necessary, which can be picked up at a local pharmacy.
Vision Services
As a member of L.A. Care Medicare Plus, you are covered for a variety of vision services including:
- One routine eye exam every year
- Up to $500 for eyeglasses or contact lenses every 2 years
To find out more about vision care covered through L.A. Care Medicare Plus, please call Member Services at 1.833.LAC.DSNP (1.833.522.3767) (TTY: 711). You can also visit the vision care's provider directory to search for a doctor.
Worldwide Emergency / Urgently Needed Coverage
L.A. Care Medicare Plus members are covered for urgent and emergency care anywhere outside the United States. L.A. Care will cover up to $10,000 in combined emergency/urgent care costs every year.
Over-the-Counter (OTC) Items
At the beginning of each calendar quarter, your OTC card is loaded with the quarterly OTC amount for your plan.
We will provide up to $150 quarterly (every 3 months) to use for approved, non-prescription OTC items. Your balance does not carry over—try to spend the full amount on the items you need before the end of each quarter.
You can use this benefit to order non-prescription OTC health and wellness items such as cough and cold medicine, vitamins, pain relievers and bandages. Your OTC allowance card, along with activation instructions and an OTC catalog will be mailed to you. View the OTC catalog.
Plus even more benefits!
Step Therapy, Prior Authorization, Quality Limit, Non-Extended Days’ Supply Restrictions Apply
Members of the L.A. Care Medicare Plus plan must be fully eligible for Medi-Cal benefits. These Medi-Cal members qualify to receive “Extra Help”. Extra Help is a program that assists members in paying for their monthly premiums, annual deductibles, and co-payments related to Medicare prescription drug coverage. Members who lose Medi-Cal coverage during the year may continue to receive their Medicare benefits from the plan for up to 3 months, this is called the ‘deeming period’. Members in a deeming period may be liable for cost sharing that Medi-Cal would normally cover.
Every drug on our Drug List is in one of five (5) cost-sharing tiers. A tier is a group of drugs of generally the same type (for example, preferred generic, generic, preferred brand, etc.). In general, the higher the cost-sharing tier, the higher the cost for the drug.
Our Plan covers the following (information listed is based on a 30-day supply):
- Tier 1 (Lowest Tier) Preferred Generic: $0 Member co-pay with Extra Help; $0 Member co-pay without Extra Help
- Tier 2: $0-$10.35 Member co-pay with Extra Help; $20 Member co-pay without Extra Help
- Tier 3: $0-$10.35 Member co-pay with Extra Help; $47 Member co-pay without Extra Help
- Tier 4: $0-$10.35 Member co-pay with Extra Help; $100 Member co-pay without Extra Help
- Tier 5: $0-$10.35 Member co-pay with Extra Help; 25% coinsurance Member without Extra Help
All administrative services related to Medi-Cal pharmacy benefits billed on pharmacy claims have transitioned to Medi-Cal Rx administered by Magellan Medicaid Administration.
Members have access of up to 60 hours per year of companionship and assistance. Your selected companion can assist with Independent Activities of Daily living such as helping with light chores, exercises, technical support services, social activities and more!
Members are covered for up to 12 visits of routine foot care. These services can include trimming of the nails and cutting or removal of corns and calluses.
Members are covered for up to 45 visits per year (combined) for routine acupuncture, routine chiropractor or massage therapy visits with a participating provider. This combined benefit is offered in addition to your Medicare and Medi-Cal covered acupuncture and chiropractic service treatments for medical necessity.
This benefit is meant to keep member’s healthy and strong after an Inpatient Hospital or Skilled Nursing Facility (SNF) stay, or for a medical condition or potential medical condition that requires member to remain at home for a period of time. This benefit provides 2 meals a day for up to 14 days with a total of 28 meals delivered, following discharge.
L.A. Care members who are at risk of falls or emergencies in the home may qualify for a Personal Emergency Response System, a device that allow you to call for help in an emergency by pushing a button.
The following SSBCI benefits are offered through NationsBenefits®, an L.A. Care approved vendor.
Healthy Foods/Grocery: $30 monthly allowance with no roll over to purchase food and produce.
Utility/Gas Flex Card: $30 monthly allowance with no roll over to pay for home utilities (Electric, Gas, Heating Oil, Sanitary, Water) and gas at the pump.
To qualify for the Special Supplemental Benefits for the Chronically Ill (SSBCI), you must:
1. Complete an Initial Health Risk Assessment (HRA) if you are new to L.A. Care, or
2. Complete an Annual Health Risk Reassessment if you are an existing L.A. Care member, and
3. Have one or more of the following conditions:
- Autoimmune Disorders
- Cancer
- Cardiovascular Disorders
- Chronic Alcohol and Other Drug Dependence
- Chronic and Disabling Mental Health Conditions
- Chronic Heart Failure
- Dementia
- Diabetes
- End-Stage Liver Disease
- End-Stage Renal Disease (ESRD)
- HIV/AIDS: Chronic Lung Disorders
- Neurologic Disorders
- Severe Hematologic Disorders
Once you complete your Health Risk Assessment (HRA), we will review your HRA results and medical history to determine your eligibility. If you qualify, you will receive information from our vendor NationsBenefits® on how to access the benefit.
Transportation services that are available to L.A. Care Medicare Plus members include:
Non-Emergency Medical Transportation (NEMT)
NEMT Physician Certification Statement Form is required. This transportation type can include transport by ambulance, litter van, wheelchair van medical transportation services, and/or coordinating with para transit. These forms of transportation are authorized when:
- Your medical and/or physical condition does not allow you to travel by bus, passenger car, taxicab, or another form of public or private transportation, and
- Transportation is required for the purpose of obtaining needed medical care.
Non-Medical Transportation (NMT)
NMT Referral may be required. This benefit allows for transportation to approved medical services by passenger car, taxi, Lyft or other forms of public/private transportation.
- You will have access to an unlimited number of round-trips per year.
This benefit does not limit your non-emergency medical transportation benefit.
This is not a complete list. The benefit information described above is a brief summary, not a complete description of benefits. For more information, contact the plan or read the Member Handbook.
L.A. Care Medicare Plus (HMO D-SNP) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Enrollment in L.A. Care Medicare Plus depends on contract renewal.
L.A. Care Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
You can get this information for free in other languages. Call 1-833-522-3767 (TTY 711), 24 hours a day, 7 days a week, including holidays. The call is free.
You can get this information for free in other formats, such as large print, braille, and/or audio. Call 1-833-522-3767 (TTY: 711), 8 a.m. to 5 p.m., Monday through Friday. The call is free.
For more information, contact us by:
Phone:
For more information on becoming a member, call us at 1-833-592-3767 (TTY: 711), 24 hours a day, 7 days a week, including holidays.
If you are a member of L.A. Care Medicare Plus and have questions, call Member Services at 1-833-522-3767 (TTY: 711), 24 hours a day, 7 days a week, including holidays.
Mail:
L.A. Care Medicare Plus
Attn: Member Services Department
1055 W. 7th Street
Los Angeles, CA 90017